Billing
Supervised and concurrent services
Choose who renders on claims for supervised providers, handle overlapping services, place provider level modifiers, batch claims by day and check a chart's billing readiness.
Some payers want claims for a technician's, assistant's or student's work billed under someone else, and some do not pay twice for two services that overlap in time. These settings live on each payer's rule sets and code tabs, so each payer gets what it asks for. They apply to every discipline; behavior analysis clinics use them most (see ABA billing and payroll).
Who renders on the claim#
Each charge keeps the provider who delivered the service. The claim's rendering provider follows the payer's Bill under setting on its rule set:
| Bill under | Rendering provider on the claim |
|---|---|
| Delivering provider | The provider who delivered the service. |
| Case lead | The case lead named on the patient's coverage. |
| Supervising provider | The supervisor on the visit. |
| Group NPI | Your group: the claim carries no separate rendering provider. |
| Clinic default | The clinic's choice in Setup, Claim Forms, Rendering provider (Delivering provider until you change it). |
When the payer bills under the case lead or the supervisor and the coverage names no case lead (or the visit has no supervisor), the claim scrubber blocks the line with a link to fix it.
Overlapping services#
When two of a patient's services overlap, for example an analyst directing a technician during the technician's session, the payer may not pay for both. Each line keeps its exact start and stop time, worked out from the visit's time and its lines' minutes in order.
On the payer's Code rules tab, under Concurrency rules, click New Concurrency Rule, enter the Primary code (whose time wins) and the Concurrent code (whose line changes), and choose what the payer does:
- Allow the overlap: both lines bill in full. This is also what happens with no rule.
- Carve the overlap out: the overlapping minutes come off the concurrent line, and its units follow.
- Deny: split off a non-billable piece: the concurrent line splits into billable time before and after the overlap and a Non-billable piece for the overlap itself. The non-billable piece never goes on a claim, but payroll still pays the provider for the whole session.
Charges show the change in their history. When the second service arrives after the first one was already billed, the scrubber blocks the claim line until you correct it.
Provider level modifiers#
Some payers want a modifier for the education level of the provider who delivered the service (HM, HN, HO or HP). Add one modifier rule per level for that payer and pick its Provider level. The level comes from the provider's credential type, so a payer that does not want level modifiers simply has no such rules.
Telehealth#
A payer's rule set picks its telehealth place of service (02 or 10), its modifier (95, GT or 93 for audio only) and, optionally, the only codes it pays by telehealth.
Group codes#
A code with a group size on its code rules bills one line per attending patient. When fewer or more patients attended than the code allows, its charges wait in charge review with Group size out of range.
Claim batch days and line times#
- Claim batch days on a rule set limit Create claims to those weekdays for the payer, for payers that want weekly batches. Charges picked by hand onto one claim bill any day.
- Line start and stop times in line notes puts each line's times in its claim line note, for payers that want one line per session with its times.
Billing readiness#
A patient's Coverage tab shows Billing readiness: a referring physician with an NPI on the open episode, a home address, a primary diagnosis and an NPI for whoever renders under the primary payer's rule. Each missing item links to where you fix it, and the list updates as you do.